This application relates generally to surgical access systems and more specifically to trocars and other such surgical access devices and specifically to laparoscopic surgical access devices for use in minimally invasive surgical procedures and laparoscopic procedures that result in crowded surgical operating fields.
Surgical access devices are commonly used to facilitate the introduction of surgical instruments through body conduits and into body cavities. A trocar is such a surgical access device and is used in laparoscopic procedures to provide access through the abdominal wall and into the abdominal cavity. In laparoscopic surgeries, the abdominal cavity is commonly inflated or insufflated in order to increase the volume of the working environment. Under these circumstances, one or more valves or seals are provided in a seal housing of the trocar to inhibit the escape of the insufflation gas. The valves form an instrument seal in the presence of an instrument, and a zero seal in the absence of an instrument.
Trocar systems have been of particular advantage in facilitating minimally invasive surgery across a body wall and within a body cavity. This is particularly true in abdominal surgery where trocars provide working channels across the abdominal wall to facilitate the use of instruments within the abdominal cavity. Trocar systems may include a cannula, which provides the working channel, and an obturator that is used to place the cannula across a body wall, such as the abdominal wall. The obturator is inserted into the working channel of the cannula and pushed through the body wall with a penetration force of sufficient magnitude to result in penetration of the body wall. Once the cannula has traversed the body wall, the obturator can be removed.
With the cannula in place in the body wall, various instruments, only one at a time, may be inserted through the cannula into the body cavity. One or more cannulas may be used during a procedure. During the procedure, the surgeon manipulates the instruments in different cannulas, sometimes using more than one instrument at a time. Additionally, during laparoscopic procedures, a trocar can be inserted through a body wall and into body cavity through a small opening, incision or puncture. It has been found that the cannula or tube of the trocar must be larger than the instrument to be used within it. It is the goal of laparoscopic surgeons to keep the incision as small as possible. However, the outer diameter of the cannula can largely drives the size of the incision. Efforts are thus made to reduce the wall thickness, the outer diameter, or both of trocar cannulas and thereby reduce the need for large incisions.
Laparoscopic surgery is also well accepted and has evolved to where surgeons are performing complex procedures through fewer and fewer access ports or devices. In some cases complex procedures may be performed through only one access device. It has become evident that a typical access device such as a trocar may not always be the most efficient tool in a crowded laparoscopic surgical environment. For example, trocars may conflict with one another and compete for space in the operative field. In addition, the bulk of a trocar may not be acceptable as it sometimes restricts movement of surgical instruments and shortens the operative length of the instrument by the height of the trocar seal housing. There is also the restriction associated with the tubular construction of the cannula associated with the trocar. These issues can be of additional concern when a surgeon seeks to perform a procedure from a single site where instrument length and mobility can be critical.